Healthcare Provider Details

I. General information

NPI: 1154414100
Provider Name (Legal Business Name): DELINA LILA FAJARDO RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 CENTRAL AVE STE 201
FAR ROCKAWAY NY
11691-4002
US

IV. Provider business mailing address

3343 PORT ROYALE DR S APT 101
FT LAUDERDALE FL
33308-7933
US

V. Phone/Fax

Practice location:
  • Phone: 718-831-2755
  • Fax:
Mailing address:
  • Phone: 201-232-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: